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Credentialing Specialist in Latham, NY at Beacon Health Options

Date Posted: 3/19/2019

Job Snapshot

Job Description


The Credentialing Specialist I is responsible for credentialing and recredentialing of behavioral health providers and facility organizations (hospitals, mental health centers, etc).  The Credentialing Specialist I is responsible for collecting credentialing documentation and accurately building provider credentialing files according to contractual and NCQA standards using Beacon’s NetworkConnect Credentialing System. The Credentialing Specialist I position requires independent business decisions to be made to complete credentialing files prior to submission to the Credentialing Committee. The Credentialing Specialist I is responsible for functions including but not limited to initial review of practitioner and facility applications, management of recredentialing files, and obtaining primary source verification for completion of credentialing and recredentialing files. The Credentialing Specialist I also acts as a resource to department team members and external departments in the day-to-day functions of the Credentialing Department.

Position Responsibilities:

  • Credential and recredential behavioral health providers and facility organizations (hospitals, mental health centers, etc.) using Beacon’s NetworkConnect credentialing system.
  • Perform verbal, written and on-line primary source verification for individual and facility organizations including but not limited to, state licensure, prescribing certificates/registrations, education, training and certification verification, accreditation status and exclusion data-base checks.
  • Accurately and timely perform data entry of all primary source verifications and select provider demographic and practice location information into Beacon’s NetworkConnect credentialing system.
  • Stay current with knowledge of NCQA credentialing standards.
  • Credential and prepare credentialing and recredentialing files for weekly Medical Director submission and bi-weekly National Credentialing Committee submission.
  • Monitor work queue to ensure applications are processed within expected turnaround times.
  • Meet or exceed production and quality standards.
  • Display a positive, constructive, and helpful demeanor.
  • Other duties as assigned.

Position Requirements:

Education : High School or Equivalent

Relevant Work Experience:

  • 2 years’ experience in insurance, medical, healthcare or related field required.
  • P rofessional demeanor, strong written and oral communication skills, strong computer skills, and the ability to learn Beacon’s internal systems.
  • Ability to learn quickly.
  • Detail-oriented, analytical, highly organized and possessing problem-solving skills.
  • Ability to manage varying job pressures, and meet deadlines and handle multiple tasks simultaneously with minimal supervision.
  • Ability to work in a production environment and meet production and quality goals.
  • Computer literacy and experience with Microsoft office programs (Outlook, Word and Excel), and internet searches. Knowledge working with fax machines, copiers and other office machines.

To Apply:

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Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment.  EOE/AA/M/F/Veterans/Disabled